| NPI | 1336555184 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024182236) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.377322) |
| 363L00000X Nurse Practitioner (Licence: IL 209.011704) | |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2022-12-08 |